In selected clinical stable mCRPC patients with limited disease progression on AA + P, a steroid switch from prednisone to dexamethasone can lead to PSA and radiological responses.

No abstract

The injection of Botulinum toxin type A (BoNT/A) into the prostate is a minimally invasive alternative treatment for lower urinary tract symptoms. To summarize the action mechanisms of BoNT/A on experimental animals and to analyze its effectiveness according to published clinical studies, we located 24 papers on the treatment of HBP with BoNT/A. The doses applied ranged from 100 (OnabotA) to 600 U (OnabotA and AbobotA). The IPSS score presented a mean post-treatment reduction, for all series, of 10.8 + 2.66 points. Other significant results included the overall mean reduction in QoL score of 2.1 ± 0.62 points, and the pre and post-treatment differences in prostate volume (22.43 ± 20.2 cm(3)), post-voiding residue (76.77 + 51.72 cm(3)) and PSA (1.15 + 0.93 ng/ml). However, only two clinical trials were on sufficient quality to be selected for meta-analysis, and it was observed that the difference of the means, pre- and post-treatment of maximum flow, prostate volume, IPSS and PSA were not statistically significant (P = 0.18). Neither was there any statistically significant difference between pre- and post-treatment post-voiding residue (P = 0.65). In conclusion, BoNT/A alleviates lower urinary tract symptoms due to HBP, but different studies present considerable variations regarding the dose administered, inclusion criteria and follow-up time, as well as poorly defined retreatment, losses to follow up and, above all, a high degree of variability in the communication of results (with large standard deviations). In consequence, further clinical trials are needed.

La uretroplastia dorsal descrita por Barbagli ha ganado amplia aceptación en el tratamiento de la estenosis de uretra, dada la simplificación que otorga la obtención del injerto libre frente a los pediculados.